| NPI | 1992544498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WI 17598-33) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 0038291) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2026-01-28 |